Event:

Focal hand dystonia in the musician (FHDM) is a painless, playing-specific finger/hand control problem that musicians may develop at a mean age of 33 and that usually ends a performing career. Symptoms resemble writer’s cramp (music cramp). Hand function in non-playing tasks is generally normal. The aetiology remains unknown. Well into the past century, FHDM was considered to be psychologically determined, a form of hysterics. At present, genetic and central-nervous-system (CNS) abnormalities have been found in many forms of dystonia. However, such abnormalities are not found in the same degree in FHDM.
In FHDM, a prevailing neurological paradigm is that genetic predispositions would deteriorate CNS motor patterns of excessively repeated motions. In contrast, a hypothesis will be presented as to how individual peripheral (hand) factors may trigger FHDM. Such factors would make certain playing motions more difficult to execute than normally and would drive compensatory behaviour, which could eventually result in dysfunctionally overcompensated motor patterns. Though still controversial, this hypothesis allows for FHDM development without CNS predispositions, although it by no means excludes CNS (co)factors. Yet, the hypothesis states that in many cases FHDM would not have developed without peripheral factors.

Our hypothesis allows for individualized treatments tailored to individual-specific factors. Again, in contrast to present-day treatments based on neurological population statistics that may have little relevance to individual cases, which could correlate with the current high treatment-failure rates. The hypothesis will be illustrated by cases from a musician’s hand clinic in the Netherlands.
In conclusion, evidence is presented that FHDM should be approached, aetiologically and clinically, as a movement disorder with deep peripheral involvement that cannot be resolved by considering genetic or CNS factors alone.